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<br />--~-~._- -----. <br /> <br />I <br /> <br />CHANGE ORDER <br /> <br />I <br /> <br />(fnstrtfc1ions on reverse side) <br /> <br />No. <br /> <br />I <br /> <br />PROJEC ,....,...... _........,.... ..' _.......... . , <br /> <br />I <br /> <br />DATE OF ISSUANCE <br /> <br />. ~ . . .. . .. . . . . 4 ~ . 4 .. .. 4 . 4 . ~ . .. . . iii . .. . ... <br /> <br />EFFE CI1VE DATE ......,..... _ . . . . . . .. . ... , .. . .. .. . . .. .. . ... . <br /> <br />~R--~~.......,...... ... .........,..,.. ..............,...,.....,......,......,.........,............. .......... ........ <br /> <br /> <br />~R" Contract No. . .......:........................... <br /> <br /> <br />CONTRACTOR .................................. ENGINEER .......................,..,...,."......,..,. _ _ _ _.. <br /> <br />'I <br /> <br />I <br /> <br />You are directed to make the fOllowing changes in the Comract Documents. <br /> <br />Description: <br /> <br />,I <br /> <br />Reason for Change Order. <br /> <br />Attachments: (List documents ~upporting change) <br /> <br />I <br /> <br />CHAi'lGE IN CONTRACT PRICE: <br /> <br />CHANGE IN CONTRACT TIMES: <br /> <br />OnginaJ Contract Price <br /> <br />I <br /> <br />s <br /> <br />OtiglnaJ Contract Time~ <br /> <br />SubstantiaJ Completion: <br />Ready for fmaJ paymem: <br /> <br />:1 Net changes from previous Change Orde~ No. _ to No. _ <br />S <br /> <br />~t'1 ot"'q.-.d <br /> <br />Net change from previous Change Orders No. _:0 No. _ <br /> <br /><Ion <br /> <br />I <br /> <br />COntract Pnce poor [0 this Charlge Order <br /> <br />I <br /> <br />s <br /> <br />-- COntract Times poor to this Change Order <br /> <br />SubstantlaJ Completion: <br />Ready for finaJ payment: <br /> <br />4-31rl or D.un <br /> <br />I, s <br /> <br />:-Ie: lncrr:ase (decrease) of tnis Change Order <br /> <br />Net (ncre~e (decrc:l:ie, of this Change Order <br /> <br />.un <br /> <br />I CJI1(r.lC[ Pnce with all approved Change Oraer> <br /> <br />Contl<lc: Times with aU approved Change Orders <br /> <br />I <br /> <br />Substantial Complellon: <br />Ready for finai payment: <br /> <br />oJltf1 O'Q.l.Cc <br /> <br />I <br /> <br />RECOMMENDED: <br /> <br />,...PPROVED: <br /> <br />ACCEPTED: <br /> <br />By: <br /> <br />~n,,_~ I^UH'O,,,ca S'~I <br /> <br />By' <br /> <br />J...Mr '^UlnonZ.~ 51IJ'WtYI"eJ <br /> <br />By: <br /> <br />~naor _^,,"f'IOf'fZecI .:Jtf1't:*I"'"" <br /> <br />I Dati:: <br /> <br />EJCDC ~o. ]910----3-8 (]99Q Edition) <br />I I ?~~~d b' '" E,~'''n 10;" C""n~ """m.,,, C""m"", ''" ."""""" 'y Ch. .,~=,,,"" G.,,= C,"'~"on of Am','~ <br /> <br />Date: <br /> <br />Dale: <br />